Cytomegalovirus endotheliitis with recurrent anterior uveitis and secondary glaucoma misdiagnosed as HLA-B27 uveitis

A 61-year-old male patient presented with decreased vision and recurrent redness in his right eye since the past 4 years. He had been diagnosed elsewhere as HLA-B27 positive anterior uveitis and was on oral methotrexate and topical corticosteroids for recurrent disease. He was on maximal medical therapy for glaucoma. Examination showed prominent inferior corneal oedema with pigmented keratic precipitates and elevated intraocular pressure. He underwent combined trabeculectomy with mitomycin C and cataract surgery. The aqueous sample tested positive for cytomegalovirus. He responded well to oral valganciclovir with resolution of uveitis, the intraocular pressure was well controlled and the corneal oedema resolved completely.

Download Full-text

Dynamics choroidal thickness in anterior uveitis without visible retinal changes

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-204-207 ◽

2021 ◽

pp. 204-207

Author(s):

E.V. Udovichenko ◽

◽

E.L. Sorokin ◽

L.P. Danilova ◽

◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Uveitis ◽

Choroidal Thickness ◽

Main Group ◽

Hla B27 ◽

Acute Anterior Uveitis ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose. To assess the state of the choroid in patients with HLA-B27-associated anterior uveitis without detectable lesions of the macular zone by ophthalmoscopy. Material and methods. 22 patients with HLA-B27-associated acute anterior uveitis without detectable changes in the macular zone by ophthalmoscopy – the main group. Age: 39.02±13.76 years, men – 16 and women – 8. Best corrected visual acuity varied from 0.1 to 0.5 (average 0.3). The level of intraocular pressure according to Maklakov in all eyes varied from 15 to 22 mm Hg. The parameters of paired intact eyes of patients served as a control. The subfoveal choroid thickness (CT) was determined using optical coherence tomography in comparison with paired intact eyes before treatment and 2 weeks after its initiation. Results. The initial values of the CT indexes in the main group varied from 337 to 371 μm, averaging 354±8 μm. This is statistically significantly higher than in intact paired eyes 255±7 μm (from 246 to 268 μm), p <0.001. 2 weeks after the start of treatment CT indexes in the main group were 268±10 μm, which was statistically significantly lower than the initial indexes in this group, p<0.001. In paired eyes, they were 254±6 μm. Conclusion. A statistically significant increase in CT was revealed in the eyes of patients with acute anterior uveitis, which statistically significantly exceeded the values of the paired intact eye on average on 100 μm. 2 weeks after the start of treatment, the CT indexes statistically significantly decreased to 268±10 μm, which did not differ statistically significantly from the CT indexes of the intact eye. Key words: anterior uveitis, HLA-B27, choroidal thickness.

Download Full-text

Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317044 ◽

2020 ◽

pp. bjophthalmol-2020-317044

Author(s):

Mandy O M Wong ◽

Amy H Y Yu ◽

Carmen K M Chan

Keyword(s):

Intraocular Pressure ◽

Anterior Uveitis ◽

Case Series ◽

Glaucoma Surgery ◽

Rank Test ◽

Monocyte Count ◽

Efficacy And Safety ◽

Retrospective Case ◽

Oral Valganciclovir ◽

Topical Medications

Background/aimsWhile cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in long-term intraocular pressure (IOP) control is not well established. Our study aims to identify the 2-year efficacy and safety of oral valganciclovir in CMV AU with uncontrolled IOP.MethodsIn this retrospective case series, one eye from each of 17 immunocompetent PCR-proven patients with CMV AU who received a single course of oral valganciclovir for 20–148 days for medically uncontrolled IOP during 2008–2018 were identified. They were examined at baseline, week 2, months 1, 2 and 3, then every 3 months up to 2 years after commencement of valganciclovir, or until IOP-lowering procedure.ResultsMedian baseline IOP and IOP-lowering medication were 27.0 mm Hg (IQR: 22.9–31.0 mm Hg), and 4.0, respectively. IOP was significantly lower than baseline from 2 weeks to 12 months and at 21 and 24 months after starting valganciclovir (p=0.001 to 0.041, Wilcoxon sign-rank test), with 16.9–46.0% median IOP reduction. Seven (41.2%) and six (35.3%) patients had IOP≤21 mm Hg with same, or reduced, topical medications by 12 and 24 months, respectively. Median time to IOP-lowering intervention or second course of valganciclovir was 12.4 months. There was no serious medication-related adverse event. Common side effects included reduced monocyte count (9 patients) and deranged renal function/electrolytes (5 patients). IOP spike and wound leak occurred in 35.5% and 29.4% of patients, respectively, after diagnostic aqueous tap.ConclusionIn CMV AU with uncontrolled IOP, >1/3 of the patients avoided glaucoma surgery over 2 years with a course of oral valganciclovir.

Download Full-text

CFH I62V as a Putative Genetic Marker for Posner-Schlossman Syndrome

Frontiers in Immunology ◽

10.3389/fimmu.2021.608723 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ming Ming Yang ◽

Hong Yan Sun ◽

Ting Meng ◽

Shan Hu Qiu ◽

Qi Qiao Zeng ◽

...

Keyword(s):

Intraocular Pressure ◽

Genetic Association ◽

Association Analysis ◽

Anterior Uveitis ◽

Genetic Background ◽

Interaction Analysis ◽

Human Leukocyte ◽

Hla B27 ◽

Complement Pathway ◽

Increased Risk

Objective: Posner-Schlossman syndrome (PSS), also known as glaucomatocyclitic crisis, is an ocular condition characterized by recurrent attacks of anterior uveitis and raised intraocular pressure. Previous studies by our team and others have identified the genetic association of complement pathway genes with uveitis and glaucoma. This study aimed to investigate the complement genes in PSS patients with the view of elucidating the genetic background of the disease.Methods: A total of 331 subjects (56 PSS patients and 275 controls) were recruited for this study. We selected 27 variants in six complement pathway genes (SERPING1, C2, CFB, CFH, C3, and C5) and detected them using TaqMan single nucleotide polymorphism (SNP) Genotyping Assays. Univariate SNP association analysis, haplotype-based association analysis, gene-gene interaction analysis among complement genes, and genotype-phenotype correlation analysis were performed.Results: Among the 27 variants of six complement pathway genes, the functional variant I62V (rs800292) at the CFH gene was found to be significantly associated with PSS; there was a significant increase in the frequency of A allele and AA homozygosity in PSS patients than in controls (P = 1.79 × 10−4; odds ratio (OR) 2.18, 95% CI: 1.44–3.29; P = 4.65 × 10−4; OR 3.66, 95% CI: 1.70–7.85, respectively). The additive effect of CFH-rs800292 and SERPING1-rs3824988 was identified with an OR of 12.50 (95% CI: 2.16–72.28). Genotype-phenotype analysis indicated that the rs800292 AA genotype was associated with a higher intraocular pressure and higher frequency of recurrence. Unlike a high proportion of human leukocyte antigen (HLA)-B27 positivity in anterior uveitis, only 3 in 56 (5.36%) PSS patients were HLA-B27 positive. In addition, one haplotype block (GC) in the SERPING1 gene showed a nominal association with PSS with an increased risk of 2.04 (P = 0.01; 95% CI: 1.18–3.53), but the P-value could not withstand the Bonferroni correction (Pcorr > 0.05).Conclusion: This study revealed a genetic association of a CFH variant with PSS as well as its clinical parameters, implying that the alternative complement pathway might play an important role in the pathogenesis of PSS. Further studies to enrich the understanding of the genetic background of PSS and the role of the complement system in ocular inflammation are warranted.

Download Full-text